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Diagnosing Mental Illness

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Erin Donnelly

on 15 July 2014

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Transcript of Diagnosing Mental Illness

Michael Ascher, MD
Clinical Associate in Psychiatry
Perelman School of Medicine at the University of Pennsylvania

Erin Donnelly, MA
Doctoral Candidate
Widener University, Institute for Graduate Clinical Psychology
Diagnosing Mental Illness
Sunday, March 2, 2014
NAMI Main Line

Support, Education, Awareness, Advocacy, Research
What does it mean for you or a loved one to have a diagnosis?
What is "mental health/illness"?
How do clinicians diagnose mental illness?
Why do diagnoses change over time?

Major changes to DSM-5.
How has being given a diagnosis helped?
How has it been difficult or
made things more complicated?

According to the World Health Organization:
“ A state of well-being in which
every individual

realizes his or her own abilities,
can cope with the normal stresses of life,
can work productively and fruitfully,
and is able to make a contribution
to his or her community.”
Mental health is...
Biological Factors
Genetic inheritance/predisposition


Immune response

HPA axis/stress reactivity/
fight-flight-freeze response

Chronic physical illness/disability

Effects of medications

Psychological Factors







Coping mechanisms/
stress management strategies
Social Factors

Racial/gender/sexual identity

Family background

Cultural/religious traditions

Interpersonal relationships/
social support

Socioeconomic status

So, what is "mental illness"?
* Mental or behavioral pattern that causes
distress or disability
* Interferes with daily living activities
* Affects how a person feels, acts, and thinks,
as well as how he or she perceives and
interacts within his or her environment and
* Categorized differently depending on culture
With knowledge comes...
& empathy

to better understand those who live with mental illness.
is often used to convey a feeling of sorrow for what another
person is feeling or going through,
without necessarily relating

is about listening for and acknowledging feelings, or having the
willingness to understand

How many people are affected by mental illness?
How do you define "health"?
What is "normal" or "typical"?
One in five
adolescents (20%) will develop a mental illness...
* Fewer than
of adults and
of children with a diagnosable mental illness will receive mental health services in a given
One in four
adults (25%) will develop a mental illness at some point in their lives...
What do you think of when someone says
"... The DSM-5 is a “living document” and will undergo continuous revision.
The hope is that the DSM-5 will more clearly inform treatment planning, medication choices, protocols, insurance reimbursements,
and research agendas
throughout the world..."
Putting it in perspective:
* places an emphasis on dimensional assessments that highlight both the presence of symptoms and the severity

The DSM-5:
Section 1
Section 1 of DSM-5 is the introduction and guides the clinician how to use the new manual.

Section 3
Section 3 features conditions that require additional research.
Section 2
Section 2 attempts to sequence diagnostic chapters developmentally by age. It also groups similar disorders in new chapters, and similar chapters adjacent to each other.

What are the major changes to the DSM-5?

Overarching Changes

Bipolar and Depressive Disorders
Schizophrenia Spectrum and Other Psychotic Disorders
Anxiety Disorders
Obsessive-Compulsive and Related Disorders
Trauma and Stress-Related Disorders
Neurodevelopmental Disorders
Neurocognitive Disorders
Substance Use Disorders
Feeding and Eating Disorders
Sexual Dysfunctions

Defining "
...is a reality.
• Involves a personal recognition of the need for change and transformation.
• Is holistic and strengths-based.
• Has cultural dimensions and encourages individuality.
• Exists on a continuum of improved health and wellness.
• Emerges from hope and gratitude; uses language of possibility.
• Involves a process of healing and self-redefinition.
• Involves addressing discrimination and transcending shame and stigma; promotes accurate and positive portrayals of psychiatric disability while fighting discrimination.
• Is supported by peers and allies; involves service users, family members and other natural supports.
• Involves (re)joining and (re)building a connected life in the community.
"There are many pathways to recovery... Recovery is a process of change that permits an individual to make healthy choices and improve the quality of his or her life." - SAMHSA

• Helps people develop valued social roles, interests and hobbies, and other meaningful activities.
Main changes:
- Emphasis on the dimensional nature of mental disorders
- Elimination of multiaxial system
- Now a simple list of physical and mental diagnoses in order of clinical importance
Mood Disorders
Bipolar and Depressive Categories
Bipolar Disorders:
- Changes in mood & activity level/energy
- No mixed episodes, only mixed features
- Anxious distress specifier
Major Depressive Disorder:

- Bereavement specifier
- Anxious distress specifier
Depressive Disorders:

- Premenstrual Dysphoric Disorder
- Disruptive Mood Dysregulation Disorder
- Persistent Depressive Disorder
Schizophrenia Spectrum
and Other Psychotic Disorders

Delusional Disorder- A person can now be diagnosed if they have bizarre delusions.
- Eliminated subtypes

- Clarified mood symptoms->
major mood episode must be present
for the majority of the time
Anxiety Disorders
Anxiety Disorders:
- separate from OCD, Trauma
- Panic Disorder & Agoraphobia separate and not mutually exclusive
- Panic attack specifier
- Social Phobia = Social Anxiety Disorder
Obsessive Compulsive and Related Disorders
Obsessive Compulsive Disorder:

- Separation Anxiety Disorder in Adults
Body Dysmorphic Disorder

- Hoarding Disorder
- Excoriation Disorder (Skin Picking)
- Trichotillomania (Hair-Pulling) Disorder
- Level of Insight specifier
Trauma and
Stress-Related Disorders

PTSD/Acute Stress Disorder:
- Negative alterations in cognitions and mood
- Hyperarousal includes irritable behavior, angry outbursts, reckless/self-destructive behavior
- Re-experiencing
- Avoidance

Derealization Disorder
Reactive Attachment Disorder:
- now Reactive Attachment Disorder and Disinhibited Social Engagement Disorder
Adjustment Disorders included
Dissociative Identity Disorder
Neurodevelopmental Disorders
Substance Use
Feeding and Eating Disorders
Sexual Disorders
Intellectual Disability
Communication Disorders
Autism Spectrum Disorder
Hyperactivity Disorder
Specific Learning Disorders
Motor Disorders
- Mild, moderate, severe, profound determined by adaptive functioning in conceptual, social and practical domains
- Language Disorder
- Speech Sound Disorder
(previously Phonological Disorder)
- Childhood-onset Fluency Disorder (previously Stuttering)
- Social (pragmatic) Communication Disorder
- Collapsed Autistic Disorder, Asperger's Disorder, Childhood Disintegrative Disorder, Rett's Disorder and Pervasive Developmental Disorder NOS
- Age of onset by 12 years old
- Subtypes replaced with specifiers
- No comorbidity with certain other disorders
- Separate specifiers for specific areas of deficits in reading, writing and math
- Developmental Coordination Disorder
- Stereotypic Movement Disorder
- Tourette's Disorder
- Persistent Motor or Vocal Tic Disorder
- Provisional tic Disorder
- Other Specified and Unspecified Tic Disorders
- Throughout the entire manual, disorders are framed in age, gender, developmental characteristics.

- Organization of chapters is designed to demonstrate how disorders are related to one another.
Emotional well-being
Psychological well-being
Social well-being
Indicators of mental health can be represented in three domains:
perceived life satisfaction, happiness, cheerfulness, peacefulness, etc.
self-acceptance, personal growth, openness to experience, optimism, hopefulness, purpose in life, control of environment, spirituality, self-direction, positive relationships
social acceptance, beliefs in potential of people and society, personal self-worth and usefulness to society, sense of community
Major Neurocognitive Disorder
Mild Neurocognitive Disorder
May include: Alzheimer's disease, Frontotemporal lobar degeneration, Lewy body disease, Vascular disease, Traumatic brain injury, Substance/medication use, HIV infection, Prion disease, Parkinson's disease, Huntington's disease
Binge Eating Disorder
Obesity removed
Bulimia Nervosa:
- once weekly purge
Anorexia Nervosa:
- improved clarification of significantly low weight
Sexual Dysfunctions:
- 6 month duration
- Lifelong vs. Acquired
- Generalized vs. Situational
Female Sexual Arousal/Desire Disorder
Genito-pelvic Pain/Penetration Disorder
(previously Vaginismus and Dyspareunia)

Gender Dysphoria:
- sex and gender as separate concepts
- no longer binary
- separate criteria for Children, Adolescents/Adults
- eliminated sexual attraction specifier
split - replaced by
spectrum of "Use"
Mild: 2-3 symptoms
Moderate: 4-5 symptoms
Severe: 6+ symptoms
Individual Profile:
- impaired control
- social impairment
- risky use
- intoxication
- withdrawal
- tolerance
Sedatives, Hypnotics, or Anxiolytics
Other (or unknown)
Michael Ascher: michaelaschermd@gmail.com

Erin Donnelly:
Helpful Resources
NAMI: www.nami.org

SAMHSA: www.samhsa.gov

Biopsychosocial Model
- Not otherwise specified replaced by two categories "Other specified __ disorder"
and "Unspecified __ disorder"

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